Lack Of Insurance May Have Figured In Nearly 17,000 Childhood Deaths In US, Study Shows

Date:

October 29, 2009

Source:

Johns Hopkins Medical Institutions

Summary:

Lack of health insurance might have led or contributed to nearly 17,000 deaths among hospitalized children in the United States in the span of less than two decades, according to new research.

Share:

Total shares:

FULL STORY

Lack of health insurance might have led or contributed to nearly 17,000 deaths among hospitalized children in the United States in the span of less than two decades, according to research led by the Johns Hopkins Children's Center.

According to the Hopkins researchers, the study, to be published Oct. 30 in the Journal of Public Health, is one of the largest ever to look at the impact of insurance on the number of preventable deaths and the potential for saved lives among sick children in the United States.

Using more than 23 million hospital records from 37 states between 1988 and 2005, the Hopkins investigators compared the risk of death in children with insurance and in those without. Other factors being equal, researchers found that uninsured children in the study were 60 percent more likely to die in the hospital than those with insurance. When comparing death rates by underlying disease, the uninsured appeared to have increased risk of dying independent regardless of their medical condition, the study found. The findings only capture deaths during hospitalization and do not reflect deaths after discharge from the hospital, nor do they count children who died without ever being hospitalized, the researchers say, which means the real death toll of non-insurance could be even higher.

"If you are a child without insurance, if you're seriously ill and end up in the hospital, you are 60 percent more likely to die than the sick child in the next room who has insurance," says lead investigator Fizan Abdullah, M.D., Ph.D., pediatric surgeon at Hopkins Children's.

The researchers caution that the study looked at hospital records after the fact of death so they cannot directly establish cause and effect between health insurance and risk of dying. However because of the volume of records analyzed and because of the researchers' ability to identify and eliminate most factors that typically cloud such research, the analysis shows a powerful link between health insurance and risk of dying, they say.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," says co-investigator David Chang, Ph.D. M.P.H. M.B.A. "The point here is that a substantial number of children may be saved by health coverage."

"From a scientific perspective, we are confident in our finding that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance," he adds.

Given that more than 7 million American children in the United States remain uninsured amidst this nation's struggle with health-care reform, researchers say policymakers and, indeed, society as a whole should pay heed to their findings.

"Thousands of children die needlessly each year because we lack a health system that provides them health insurance. This should not be," says co-investigator Peter Pronovost, M.D., Ph.D., director of Critical Care Medicine at Johns Hopkins and medical director of the Center for Innovations in Quality Patient Care. "In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue," he adds.

In the study, 104,520 patients died (0.47 percent) out of 22.2 million insured hospitalized children, compared to 9, 468 (0.75 percent) who died among the 1.2 million uninsured ones. To find out what portion of these deaths would have been prevented by health insurance, researchers performed a statistical simulation by projecting the expected number of deaths for insured patients based on the severity of their medical conditions among other factors, and then applied this expected number of deaths to the uninsured group. In the uninsured group, there were 3,535 more deaths than expected, not explained by disease severity or other factors. Going a step further and applying the excess number of deaths to the total number of pediatric hospitalizations in the United States (117 million) for the study period, the researchers found an excess of 16,787 deaths among the nearly six million uninsured children who ended up in the hospital during that time.

Other findings from the study:

More uninsured children were seen in hospitals in the Northeast and Midwest than in the South and West. However, hospitals from the Northeast had lower mortality rates than hospitals from the South, Midwest and West.

Insured children on average incurred higher hospital charges than uninsured children, most likely explained by the fact that uninsured children tend to present to the hospital at more advanced stages of their disease, which in turn gives doctors less chance for intervention and treatment, especially in terminal cases, investigators say.

Uninsured patients were more likely to seek treatment though the Emergency Room, rather than through a referral by a doctor, likely markers of more advanced disease stage and/or delays in seeking medical attention.

Insurance status did not affect how long a child spent overall in the hospital.

The research was funded by the Robert Garrett Fund for the Treatment of Children.

July 31, 2015  Resettlement projects in the Amazon are driving severe tropical deforestation, according to new research. Widely hailed as a socially responsible and 'innocuous' strategy of land redistribution, ... read more

July 29, 2015  Following the British Medical Association's call for a 20 percent sugar tax to subsidize the cost of fruit and vegetables, experts debate whether a sugar tax could help combat ... read more

July 29, 2015  Black men in England are at double the lifetime risk of being diagnosed with, and dying from, prostate cancer compared with white men in England, according to research. The study also finds that ... read more

July 30, 2015  In a survey of hospital medical physicians across the United States, women made nearly $15,000 less than their male counterparts, with a portion of this disparity explained by female doctors' ... read more

July 30, 2015  China needs to reduce its dependence on coal and improve the range of fuels it uses if it is to have long term energy security, according to new research. The study looks at the future of electricity ... read more

July 30, 2015  It is possible to predict the timing and intensity of influenza outbreaks in subtropical climates like Hong Kong where flu seasons can occur at different times and more than once during a year, ... read more

May 6, 2015  A study of survival rates in trauma patients following health insurance reform in Massachusetts found a passing increase in adjusted mortality rates, an unexpected finding suggesting that simply ... read more

Apr. 10, 2014  Many factors influence the life expectancy of childhood cancer survivors: not getting enough exercise, being underweight, and being worried about their future health or their health insurance, ... read more

Oct. 3, 2010  One in eight parents reported that his or her child had not received pediatrician-recommended care -- medication, laboratory testing and/or appointments with specialists -- during the previous 12 ... read more